The use of psychoactive substances among residents of long-term care facilities for the elderly : perspectives of residents, providers and administrators on the current situation, challenges and improvement of practices.

Background: Dedicated to seniors with loss of autonomy, long-term care and housing facilities (LTCH) are struggling to meet the specific needs of residents who use psychoactive substances. The lack of appropriate care aggravates the impacts of consumptions, associated comorbidities, and accentuates the loss of autonomy. By documenting the perspectives of the residents of these resources, as well as those of the administrators and service providers who support them, this study aims to understand the realities, challenges and avenues for innovation regarding the support of this specific population with regard to their psychoactive substances use.

Methods: As part of a broader collaborative project, we conducted 35 semi-structured individual interviews with residents (n = 15) of LTCH facilities, service providers (n = 15) and administrators (n = 5) of these resources, and also specialized addiction services that are serving this population. We conducted a thematic analysis on the interviews content.

Results: A heterogeneous profile of the residents, based on social- and health-related characteristics, is outlined. To accompany the multiple repercussions of the use of psychoactive substances, some emerging case management practices appear. Complex residential and service trajectories are also highlighted, sometimes emphasizing the 'last resort' aspect of the arrival in a LTCH facility. A better training of LTCH resource staff regarding issues related to psychoactive substance use is pointed out, as well as a better collaboration between resources supporting the autonomy of the elderly and those specializing in addiction.

Conclusion: This study illustrates the challenges of supporting the elderly who use psychoactive substances in LTCH resources. It also highlights local innovations and areas for improvement in practices. This research initiative also facilitates the cooperation between service providers working with the elderly or in the field of addiction in order to offer an integrated support, tailored to the complex interaction between aging, psychoactive substances use, and other social- or health-related issues.